Helping People Live Healthier Helping People Live Healthier Lives Attachment E.1 Louisiana 2014 RFP

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Transcript of Helping People Live Healthier Helping People Live Healthier Lives Attachment E.1 Louisiana 2014 RFP

  •   Helping People Live Healthier Lives

     

    Attachment E.1 Louisiana 2014

    RFP # 305PUR-DHHRFP-BH-MCO-2014-MVA Page 1 of 94  

    Attachment E.1 Publicly-Funded Managed Care Contracts for Medicaid/CHIP and Other Low-Income Individuals within the Last Five Years LOUISIANA Trade Name Brief Description of the

    Scope of Work Duration of the Contract

    Contact Name and Phone Number

    Number of Members

    Population Types

    Annual Contract Payments

    Payment Type

    Role of Subcontractors, if any

    LOUISIANA

    UnitedHealthcare of Louisiana, Inc.

    Coordinated Care Network- Shared Savings: helps ensure Medicaid and CHIP members in three designated geographical service areas have access to quality health care through care management, predictive modeling and the use of patient-centered medical homes (PCMHs).

    Origination: 2011 Feb. 1, 2012 – Jan. 31, 2015

    Ruth Kennedy 225-342-3032

    274,363 TANF, ABD, CHIP

    July Actual: $3,034,498 July YTD: $20,550,096

    Administrative service organization (ASO) with gain share

    Affiliates: Care and Disease Management; Nurseline – OptumHealth Care Solutions Management Services – United HealthCare Services

           

  •   Helping People Live Healthier Lives

     

    Attachment E.1 Louisiana 2014

    RFP # 305PUR-DHHRFP-BH-MCO-2014-MVA Page 2 of 94  

    National Contracts – (Out-of-State)

    ALABAMA Trade Name Brief Description of the

    Scope of Work Duration of the Contract

    Contact Name and Phone Number

    Number of Members

    Population Types

    Annual Contract Payments

    Payment Type

    Role of Subcontractors, if any

    ALABAMA

    UnitedHealthcare of Alabama, Inc.

    UnitedHealthcare Dual Complete: As an HMO, provides a Special Needs Plan (SNP) for all dual eligible members who have full Medicaid benefits and are enrolled in Medicare Parts A and B.

    Origination: 1995 Jan. 01, 2014 – Dec. 31, 2014 Annual Renewal

    Nicole M. Edwards 415-744-3615

    8,376 Dual eligible July Actual: $59,359 July YTD: $73,445,114

    Capitated Affiliates: Dental – Dental Benefit Providers NurseLine; Physical health services (i.e., occupational therapy, physical therapy, speech therapy, etc.) – OptumHealth Care Solutions Management Services – United HealthCare Services Vision – Spectera Non-affiliates: Hearing – EPIC Hearing Healthcare (i.e., Hearing Exam/ Hearing Aids) Over the Counter – FirstLine Medical Transportation - LogistiCare 

  •   Helping People Live Healthier Lives

     

    Attachment E.1 Louisiana 2014

    RFP # 305PUR-DHHRFP-BH-MCO-2014-MVA Page 3 of 94  

    ARKANSAS/MISSOURI Trade Name Brief Description of the

    Scope of Work Duration of the Contract

    Contact Name and Phone Number

    Number of Members

    Population Types

    Annual Contract Payments

    Payment Type

    Role of Subcontractors, if any

    ARKANSAS/MISSOURI

    Care Improvement Plus South Central Insurance Company

    Care Improvement Plus Dual Advantage: a Medicare Advantage plan with a focus on chronic Dual SNP (D-SNP) plans in the states of Arkansas and Missouri.

    Origination: 2007 Jan. 01, 2014 – Dec. 31, 2014 Annual Renewal

    Nicole M. Edwards 415-744-3615

    14,971 Dual eligible July Actual: $105,385 July YTD: $115,769,513

    Capitated Affiliates: Dental – Dental Benefit Providers NurseLine – OptumHealth Care Solutions Vision – Spectera Non-affiliates: Hearing – hiHealth Innovations Transportation - LogistiCare

  •   Helping People Live Healthier Lives

     

    Attachment E.1 Louisiana 2014

    RFP # 305PUR-DHHRFP-BH-MCO-2014-MVA Page 4 of 94  

    ARIZONA Trade Name Brief Description of the

    Scope of Work Duration of the Contract

    Contact Name and Phone Number

    Number of Members

    Population Types

    Annual Contract Payments

    Payment Type

    Role of Subcontractors, if any

    ARIZONA Arizona Physicians IPA (APIPA)

    Acute Care/Uninsured Children: provides services to low-income pregnant women, families, children; ABD SSI individuals; and uninsured children in families at other income levels through the KidsCare State Children’s Health Insurance Program (SCHIP) program.

    Origination: 1982 Jan. 01, 2013 – Sept. 30, 2018

    Tom Betlach 602-417-4111

    324,496

    CHIP, SSI, TANF, uninsured children

    July Actual: $88,472,388 July YTD: $590,171,684

    Capitated Affiliates: Dental – Dental Benefit Providers Fraud, Waste and Abuse: OptumInsight Management Services – United HealthCare Services Physical health services (i.e., occupational therapy, physical therapy, speech therapy, etc.) – OptumHealth Care Solutions, Physical Health Non-affiliates: Home care – Preferred Home Care Radiology – CareCore Vision – Nationwide Transportation – MTBA

  •   Helping People Live Healthier Lives

     

    Attachment E.1 Louisiana 2014

    RFP # 305PUR-DHHRFP-BH-MCO-2014-MVA Page 5 of 94  

    Trade Name Brief Description of the Scope of Work

    Duration of the Contract

    Contact Name and Phone Number

    Number of Members

    Population Types

    Annual Contract Payments

    Payment Type

    Role of Subcontractors, if any

    ARIZONA Arizona Physician's IPA, Inc.

    Children's Rehabilitative Services (CRS): provides family-centered medical care, rehabilitation and support services to children and youth with chronic and disabling conditions or potentially disabling health conditions (e.g., bone tumors, cerebral palsy, multiple sclerosis, muscular dystrophy, sickle cell anemia, etc.).

    Origination: 2008 Jan. 01, 2013 – Sept. 30, 2018

    Tom Betlach 602-417-4111

    24,295 Special services program for children

    July Actual: $16,146,130 July YTD: $120,607,789

    Capitated Affiliates: Fraud, Waste and Abuse –OptumInsight Management Services – United HealthCare Services Physical health services (i.e., occupational therapy, physical therapy, speech therapy, etc.) – OptumHealth Care Solutions Non-affiliates: Dental – ANDA Home care – Preferred Home Care Vision – Nationwide Transportation – MTBA

  •   Helping People Live Healthier Lives

     

    Attachment E.1 Louisiana 2014

    RFP # 305PUR-DHHRFP-BH-MCO-2014-MVA Page 6 of 94  

    Trade Name Brief Description of the Scope of Work

    Duration of the Contract

    Contact Name and Phone Number

    Number of Members

    Population Types

    Annual Contract Payments

    Payment Type

    Role of Subcontractors, if any

    ARIZONA Evercare of Arizona, Inc.

    Evercare Select® – Arizona - Long-term Care System (ALTCS): a LTC health plan for certain elderly, physically disabled and chronically ill people who are recipients of Medicaid. Partially funded through a contract with the State of Arizona, members have to be enrolled in ALTCS, which is part of AHCCCS.

    Origination: 2006 Oct. 01, 2011 – Sept.30, 2016

    Tom Betlach 602-417-4111

    8,857 LTC and chronically ill

    July Actual: $26,454,478 July YTD: $183,640,467

    Capitated Affiliates: Dental – Dental Benefit Providers Fraud, Waste and Abuse –OptumInsight Management Services – United HealthCare Services NurseLine, physical health services (i.e., occupational therapy, physical therapy, speech therapy, etc.) Case Management – OptumHealth Care Solutions Non-affiliates: After-hours Answering Service/Case Management – Cosmopolitan Vision – Nationwide Transportation – LogistiCare

  •   Helping People Live Healthier Lives

     

    Attachment E.1 Louisiana 2014

    RFP # 305PUR-DHHRFP-BH-MCO-2014-MVA Page 7 of 94  

    Trade Name Brief Description of the Scope of Work

    Duration of the Contract

    Contact Name and Phone Number

    Number of Members

    Population Types

    Annual Contract Payments

    Payment Type

    Role of Subcontractors, if any

    ARIZONA Arizona Physician's IPA, Inc.

    Developmentally Disabled: provides services to residents who have chronic disabilities attributable to mental developmental disabilities, cerebral palsy, epilepsy, or autism manifested prior to age 18. Children under 6 years of age may be eligible for services if demonstrated the child is or will become developmentally disabled.

    Origination: 1988 Oct. 20, 2011 – Sept. 20, 2016

    Cecelia Andersen 602-771-8095

    15,433 Developmentally disabled

    July Actual: $6,529,720 July YTD: $45,570,588

    Capitated Affiliates: Dental – Dental Benefit Providers Fraud, Waste and Abuse – OptumInsight Management Services – United HealthCare Services Physical health services (i.e., occupational therapy, physical therapy, speech therapy, etc.); transitional and high risk care, and NICU, utilization management, and Healthy First Steps – OptumHealth Care Solutions Non-affiliates: Home Care (i.e